PROJECT SUMMARY/ABSTRACT I am applying to renew my Mid-career Investigator Award in Patient Oriented Research (K24) in order to support my research and mentoring efforts. I am fully committed to patient oriented research and to training the next generation of researchers in nephrology research. I have developed a research program studying physical functioning in patients on dialysis, characterizing their limitations, studying the pathophysiology, and evaluating interventions to improve functioning. While my previous and currently funded work aims to assess frailty and its evolution among patients on dialysis, I am convinced that physical function and frailty could add important information to inform clinical care at other points along the spectrum of CKD. In particular, I plan to expand my focus to the transitions of care from non-dialysis requiring CKD to ESRD and from dialysis to transplantation. Aims are to examine associations of functional status during CKD with outcomes during ESRD in a national cohort of veterans and to measure physical performance in a cohort of kidney transplant candidates to determine the extent to which post-transplant outcomes are related to physical performance and frailty during pre-transplant evaluation. I have a strong track record of mentoring, and I work within a rich, supportive, and collegial environment at UCSF and in the Division of Nephrology. Continued K24 funding will permit me to continue to focus more of my time on research and mentoring and less on clinical and administrative work.